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首页> 外文学位 >Racial Differences in Cardiac Catheterization Use in Patients Hospitalized with Acute Myocardial Infarction: Classifications, Associations, and Emerging Technologies.
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Racial Differences in Cardiac Catheterization Use in Patients Hospitalized with Acute Myocardial Infarction: Classifications, Associations, and Emerging Technologies.

机译：急性心肌梗塞住院患者心脏导管使用的种族差异：分类，关联和新兴技术。

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摘要

Racial differences in the use of cardiovascular procedures, including cardiac catheterization among patients hospitalized with myocardial infarction, represent a troubling feature of the US health care system. A critical appraisal of research to date suggests shortfalls in three areas. First, missing from these studies is a consideration of patient race, specifically the manner in which patient racial identification is made, and the quality of patient race identification. Misclassification of patient race, particularly if non-random, may result in biased estimates of any racial differences in treatment. Second, although studies have evaluated clinically heterogeneous populations, assessed the role of possible confounding factors, and explored the role of patient preferences as possible hypotheses for racial differences in the use of cardiac catheterization, few have focused on the appropriateness of cardiac catheterization. Racial differences in cardiac catheterization appropriateness would suggest that racial variations in cardiac catheterization use may not be clinically appropriate. Finally, it is unclear whether racial differences in cardiac catheterization extend to newer technologies that require cardiac catheterization. These three areas of concern were investigated in this dissertation.;Evaluations of patients hospitalized with myocardial infarction suggest that data used to classify patient race remains of poor quality with notable inter-hospital variation, particularly for non-white and non-black patients. Future work is needed to clarify obstacles to standardizing patient race data collection. Second, racial differences in cardiac catheterization suggest lower rates of cardiac catheterization in black patients reflects both the undertreatment of black patients and the overtreatment of white patients. Efforts are needed to eliminate such variation, which reflects poor quality of care for both populations. Finally, drug-eluting stents exhibited an adoption lag in their use among black patients compared with white patients attributable to both differential treatment within hospital and lower availability of DES at centers with higher proportions of black patients. Although this novel technology was subsequently equally utilized by white patients and black patients, future work is needed to identify processes accounting for the lag in adoption of new technology by race. Continued work in these areas will ensure that the US health care system meets its promise of providing high quality health care to all patients.
机译：使用心血管程序的种族差异，包括住院心肌梗塞患者的心脏导管插入术，代表了美国医疗体系令人不安的特征。迄今为止对研究的严格评估表明，这三个领域存在不足。首先，这些研究中缺少对患者种族的考虑，特别是对患者种族识别的方式以及患者种族识别的质量。患者种族分类错误，特别是如果是非随机种族，可能会导致对治疗中任何种族差异的估计有偏差。其次，尽管研究评估了临床上的异质人群，评估了可能混杂因素的作用，并探讨了患者偏好作为心导管使用中种族差异的可能假设的作用，但很少有人关注心脏导管的适用性。心脏导管插入术的种族差异表明，心脏导管插入术的种族差异可能在临床上不适合。最后，尚不清楚心脏导管插入术的种族差异是否扩展到需要心脏导管插入术的新技术。本文对这三个方面进行了研究。对住院心肌梗死患者的评估表明，用于对种族差的患者进行分类的数据质量差，医院间差异显着，特别是非白人和非黑人患者。需要进一步的工作来澄清阻碍标准化患者种族数据收集的障碍。其次，心脏导管插入术的种族差异表明，黑人患者的心脏导管插入率较低，这反映了黑人患者的治疗不足和白人患者的过度治疗。需要努力消除这种差异，这反映了两个人群的护理质量较差。最后，与白人患者相比，药物洗脱支架在黑人患者中的采用滞后，这归因于医院内的差异治疗以及黑人患者比例较高的中心的DES利用率较低。尽管后来白人患者和黑人患者平等地使用了这项新技术，但仍需要进一步的工作来确定导致种族歧视采用新技术的过程。在这些领域的持续工作将确保美国医疗保健系统实现其向所有患者提供高质量医疗保健的承诺。

著录项

  • 作者

    Rathore, Saif Shafique.;

  • 作者单位

    Yale University.;

  • 授予单位 Yale University.;
  • 学科 Health Sciences Medicine and Surgery.;Health Sciences Epidemiology.
  • 学位 Ph.D.
  • 年度 2011
  • 页码 103 p.
  • 总页数 103
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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